Confessions of a GP

and a Harry Potter book. Suddenly, angry man isn’t the big scary man that he was a couple of hours ago. This opportune insight into the man behind the fury warms me to him slightly. I consider trying to find a few words to break the ice, but our super-slow checkout boy has finally managed to scan all my items and it is time for me to pay. As I leave, not-so-angry man gives me an awkward nod and I wonder if our next encounter in the surgery might be a little less heated.

Maintaining interest

After practising medicine for some time, the average grumpy doctor will have seen many thousands of patients pass before him or her. In the early part of our careers we greet every medical condition with genuine intrigue and gusto, but as the years pass it can become harder and harder to muster up the enthusiasm to keep ourselves awake during slow afternoon surgeries.

Having said that, there are a few ways in which you, the patient, can grab the attention of even the most indifferent of doctors:

1. Have a rare condition. Your diagnosis should be common enough that we learnt about it at medical school but rare enough to be something that we have never actually seen before in the flesh. Be warned, however, that if it is so rare that we can’t recognise it or have never heard of it, our feelings of incompetence will lead to frustration and resentment, which will most likely be taken out on you.

2. Have a diagnosis with a good name. I love the way molluscum contagiosum rolls off the tongue. The delightful Latin words entertain me so much that I have forgiven the fact that the condition they describe is an extremely mundane skin lesion that I have seen many hundreds of times.

3. Make me laugh. I will pardon a boring medical condition if it was obtained in a comical fashion. Sprained ankles are very dull but you will be entirely absolved if you managed to achieve your sprain by trying to do the moonwalk in a kebab shop while dressed as Scooby-Doo. If you actually just sprained your ankle by stepping awkwardly off the kerb, make up a more entertaining story and your doctor will view you in a better light.

4. Be attractive. When I was working in A&E, the orthopaedic surgeons were famous for avoiding seeing patients at any cost. The only time we ever saw them demonstrate any degree of enthusiasm about their chosen profession was when a particularly beautiful dance student injured her knee. I’m sure she didn’t really need admitting but they insisted that they kept a close eye on her on the ward for a few days.

5. Have a truly embarrassing problem. It must be awful to have to tell your doctor that you have an object stuck up your bottom, but if it is any consolation, it will absolutely make your doctor’s day. For me, the icing on the cake is always the ridiculous accompanying explanation: ‘So I was trying to save water by washing the vegetables while also taking a shower and then I slipped and what are the chances of landing on that courgette…’

I am proud to say that I do listen and show interest in my patients because I still maintain enthusiasm for my job. This is not because my day-to-day work in general practice is on the cutting edge of medical science, but because I have a genuine interest in the people and the stories behind the science of the illnesses. Of course, quite rightly when you are ill or injured, you have absolutely no reason to give two monkeys’ whether your condition holds any academic curiosity or entertainment value to the doctor you’re seeing — and why should you? Just one thing, though, if at the end of a long surgery you are 15 minutes through a monologue describing the detailed chronology of your athlete’s foot, don’t be overly offended if your doctor’s eyes glaze over somewhat.

The future?

If you get a bunch of GPs in a room together, it won’t be long before they start moaning about their jobs. This never ceases to amaze me, as I think we have it fairly good at the moment. We are paid well, work good hours and have an interesting and rewarding occupation. Despite this, GPs spend a great deal of time complaining about almost everything. I even heard a couple of GP partners complaining about how high their tax bill was going to be this year. I couldn’t help but point out that if they were going to earn 120K, then they couldn’t really expect any sympathy for paying a bit more to the treasury come April!

Some of my older patients reminisce fondly about the time when their own GP was on call 24 hours a day and was always on hand for an emergency visit. My uncle was one of those GPs. He would disappear from family dinners to deliver a baby, get home at 5 a.m. and then start morning surgery at 8 a.m. with a huge line of patients queuing out into the street. There is a wonderfully romantic, old-fashioned idea about that bygone time of the loyal and dedicated family GP. My auntie still has her late husband’s ex-patients stopping her in the street and telling her what a wonderful doctor he was. My uncle had no life outside of his work and rarely spent any time with his family. He missed his children growing up and dropped down dead shortly after retiring. I wouldn’t want to have had his life. My generation of young GPs is mostly much better at finding a balance between work and home life. I’m sorry that my patients have to see a GP they don’t know if they need a doctor on a Sunday night or while I’m on holiday, but I have a life too.

All in all, I’m quite positive about the future of general practice. There are always scaremongering stories about big supermarket chains setting up surgeries and shipping in lots of Eastern European doctors to take over our jobs. I think this is unlikely. Yes, patients grumble about struggling to get through on the phone or their doctor running late, but individually most GPs are quite well liked and valued by their patients. My experience of patients is that they are a fairly loyal bunch. I’m not sure that a huge number would be lured away to Tesco if they opened surgeries at the back of their stores. I can see that some would be attracted by the convenience of supermarket doctors, especially if they ran a 24-hour service, but ultimately most patients like the familiarity and friendliness of their local practices. Although there is a lot of potential profit to be made out of running GP surgeries, there is also a hell of a lot of red tape and hoops to jump through. I’m not sure whether Tesco would really want the bother. I may eat my words someday but I think that our jobs and future are fairly secure.

Tariq

I found my first few consultations with Tariq frustrating. I struggled to understand his English and he never seemed to have much physically wrong with him. The consultations were always a bit disjointed and he always seemed reluctant to leave. Another wasted consultation, I would think to myself as he finally left my room.

Gradually, after his first few visits, Tariq began to open up to me. He was in his mid-twenties and had been tortured in a Sudanese jail after being arrested for political activity at his university. He had arrived here hidden in a lorry and was currently seeking asylum. He lived in a homeless hostel with mostly alcoholics and heroin addicts and spent his days aimlessly wandering the streets of the town centre. He was the sort of person I might walk past every day without noticing, but behind the sad tired face was a brilliant mind and a man desperate to work, study and make the most out of his life. Unfortunately, because of his asylum-seeking status, he was not entitled to do any of this. Instead, he looked enviously at the alcoholics and junkies that he lived with, knowing that as British citizens, if they so wished they could work, study and do many things that he was not entitled to do. Despite being understandably miserable here, Tariq was terrified that he would be tortured and killed if he returned to the Sudan, so he was stuck between an unpleasant rock and a horrifying hard place.

After his third or fourth visit, Tariq confessed to me that in the space of a whole week I was the only person he spoke to. If I wasn’t a GP, I would not believe that in a busy cosmopolitan city a man could spend weeks passing the time without conversing with a single soul. Most people avoid seeing their doctor if they possibly can, but for Tariq, I was his only outlet to the rest of the world. I was the only person to whom he could talk about his feelings